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Focus On Basics

Volume 1, Issue D :: December 1997

Focus on Research: Health and Literacy

by Barbara Garner

Content-based instruction serves a dual purpose: learners learn both basic skills and content. Learners' interests or the goals of the program often serve to define the content. Sometimes, "outside" agencies, such as the public health department or the census bureau, create partnerships with adult learning programs as a route of entry to the population that they, too, are mandated to serve. The Fannie Mae Foundation, a non-profit organization that provides information about home buying to the public, for example, supported the development and dissemination of an ESOL curriculum on home buying. In Massachusetts, for the past four years, a portion of the tax on tobacco has gone to support the development of health-related activities at a number of adult learning centers.

Researcher Rima Rudd has been involved in Massachusetts' health and literacy activities from their inception. Finding little written about what teachers think of content-based instruction, particularly when the content is promoted by an outside agenda, she chose to explore the experience of the adult educators who were involved in the health and literacy activities in New England. This initial work served as a pilot for a larger NCSALL study she is launching this winter.

To develop the pilot questionnaire, Rudd, who has both public health expertise and familiarity with adult learning centers, teachers, and students, sent a draft of her questionnaire to colleagues for review. The pilot study was to be a test of the questionnaire, so it included questions about whether the questionnaire was meaningful, whether questions needed rephrasing, and whether questions were was missing. The "content" aspect of the questionnaire asked about the respondent's experience with incorporating health topics into the adult literacy curriculum, and the outcome of the health project, both for the learners and the teacher. Other questions solicited information about the perceived value of health as a topic in the classroom. Respondents were also asked to consider a variety of literacy-related curriculum objectives and rate the usefulness of the health project in terms of these objectives.

The sample Rudd used was determined by participation in either the tobacco tax project or a similar project. Of the 31 eligible centers, 24 had staff available to participate in the study. The majority of the hour-long interviews were conducted in person.

Rudd and her colleagues summarized the data and mailed the findings back to the study participants to solicit their ideas about what the data reveals. She asked study participants "How can we interpret this? What do we learn from it? Where are the gaps? Of what use is this to you, the teacher?" She explains her approach to research: "I'm trying to be respectful of the practitioners I work with by combining traditional data collection with participatory problem solving. To do this, I send the findings back to people and ask them to share their reactions."

The pilot yielded information that Rudd used to fine-tune the questionnaire. The response rate was so high - 77% as compared to an expected rate of about 25% - that the findings also stand as a small exploratory study. Although all the analysis has not yet been done, Rudd found that most teachers reported that the health and literacy project increased learners' awareness of health issues and motivated behavior change as well as increased learners' reading and writing skills. Almost all of the teachers (27 of 31) reported that the topic (the aspect of health) of the project was chosen because of the adult learners' needs or interest in a particular area.

Teachers were asked if they made changes in teaching styles for the health project. This question stems from the larger inquiry of whether health topics promote certain kinds of teaching methods, compared to other subjects. Of the 31 teachers, 22 changed the way they taught, integrating more active methodologies. Teachers reported outcomes linked to student motivation, confidence, self-esteem, and empowerment. Skill development was also an outcome.

Rudd will expand this study, again, inviting respondents draw meaning from the data. Participants will also receive a bibliography on health literacy. For updates, visit the NCSALL web page or contact:

Dr. Rudd
Department of Health and Social Behavior
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115

Updated 7/27/07 :: Copyright © 2005 NCSALL